Electronic link between rival institutions reveals patient mobility

A first study of its kind has quantified the degree to which patients seek care across multiple unaffiliated medical facilities. The results suggest substantial mobility that could yield significant potential savings from the sharing of images across institutional borders.

Researchers analyzed data from the Philadelphia Health Information Exchange, the first regional network in the U.S. to electronically link competing facilities to share digital diagnostic imaging results across institutional borders. The exchange, interfaced with heterogeneous PACS and RIS at multiple facilities, indexes patient demographic and imaging data in near real-time. Researchers found a significant overlap in patient population between two major rivals in the Philadelphia market: Thomas Jefferson University Hospital and the University of Pennsylvania Health System.

In the 20-month period examined, Penn had 300,000 unique patients, while Jefferson had 137,000. Researchers found that 40,000 patients traveled between the two facilities, generating 125,000 imaging exams. Dr. Elliot Menschik, founder and CEO of the exchange, presented the study at the RSNA meeting on Monday.

Relevant prior images between the two institutions that neither knew about ranged from 1700 at one month to 10,000 at 20 months. Researchers found that nearly 70% of patients went from having a prior unknown computed radiograph to receiving another CR; 7% went from a prior CR to a CT scan; 5% went from CT to CT; 3% from CT to CR; 2% from CR to MR; and a few other combinations rounded out the data.

Researchers did not calculate the number of possible avoidable exams, such as not needing a CT if the prior CR had been known, Menschik said. In terms of clinical conditions, 36% of cases involved trauma, 36% were respiratory, 7% were circulatory, and 6% were for cancer and musculoskeletal each.

The team also found 1200 exams considered duplicative, which did not include exams taken beyond 45 days of the prior. They calculated the cost of those exams to the payer as $120,000.

"Diagnostic exchange between institutions is likely to have significant impact on quality of care" Menschik concluded.